Levodopa infusion improves impulsivity and dopamine dysregulation syndrome in Parkinson's disease

• Published in: Movement disorders Vol. 28; no. 14; pp. 2007 - 2010
• Main Authors: Catalán, María José, de Pablo-Fernández, Eduardo, Villanueva, Clara, Fernández-Diez, Servando, Lapeña-Montero, Teresa, García-Ramos, Rocío, López-Valdés, Eva
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-12-2013; Wiley Subscription Services, Inc
• Subjects: administration and dosage; Aged; Antiparkinson Agents - administration & dosage; DDS; Dopamine - metabolism; Female; Humans; impulse control disorders; Impulsive Behavior - drug therapy; Impulsive Behavior - etiology; infusion pumps; intraduodenal levodopa; levodopa; Levodopa - administration & dosage; levodopa, administration and dosage; Male; Middle Aged; Movement disorders; Parkinson Disease - complications; Parkinson Disease - drug therapy; Parkinson Disease - pathology; Parkinson's disease; Treatment Outcome; impulse control disorders; infusion pumps; DDS; intraduodenal levodopa; levodopa, administration and dosage; Parkinson's disease
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.25636

ABSTRACT
Background
Impulsivity and dopamine dysregulation syndrome are frequent complications of treatment in Parkinson's disease (PD).
Methods
We assessed the effect of jejunal levodopa infusion (JLI) on behavioral symptoms in 8 PD patients with motor complications and severe impulsivity and dopamine dysregulation syndrome (DDS), which had not be controlled before by adjusting oral medications. The infusion was delivered during 15 hours (daily dose 1007.2 ± 302.5 mg) and stopped at night time. Patients were reassessed after 25 ± 9 weeks of treatment with a stable dose of jejunal l‐dopa.
Results
Off periods and dyskinesias decreased by 27% and 20,7% respectively, compared to baseline. DDS and all types of impulse control disorders (ICDs) improved in all patients, with nearly complete symptom resolution. Punding improved in all 5 patients but disappeared completely in only 1.
Conclusions
Our experience suggests that l‐dopa infusion has a positive effect on both motor complications and behavioral disorders. This treatment approach deserves further controlled studies. © 2013 International Parkinson and Movement Disorder Society